乳腺癌前哨淋巴结定位活检的意义(附68例分析)

目的验证乳腺癌前哨淋巴结(SLN)定位和活检技术的可行性及前哨淋巴结的组织学状况是否能准确预告腋淋巴结转移特性.方法使用美蓝等对68例确认为乳腺癌患者进行术中前哨淋巴结定位活检术.结果 58例(85.3%)SLN,SLN预告腋淋巴结的准确率为91.4%(53/58),假阴性为8.6%(5/58).结论乳腺癌SLN定位活检是可行的,SLN可较为准确地反映腋淋巴结状况.     

前哨淋巴结活检在早期乳腺癌中的应用价值

目的:探讨活性染料亚甲蓝检测早期乳腺癌前哨淋巴结的可行性及其临床意义.方法:利用亚甲蓝对48例乳腺癌患者进行前哨淋巴结活检(SLNB)并同时行腋窝淋巴结清扫(ALND),根据病理结果进行评价.结果:SLN检出率为95.8% ,SLN对ALN状况预测的敏感度为 90.3%,准确率为95.7%,假阴性为6.5%,假阳性为0.结论:前哨淋巴结活检能比较准确地反映早期乳腺癌的腋窝淋巴结转移情况,可为SLN阴性的患者"保腋窝"提供依据.     

乳腺癌前哨淋巴结定位和活检

目的：难证乳腺癌前哨淋巴结定位和活检技术的可行性和前哨淋巴结的组织状况能否准确预告腋淋巴结的状况。方法：本研究使用专利蓝,对３３例乳腺癌患者进行了术中及术后前哨淋巴结定位和活检术。结果：３０例（９１％）找到前哨淋巴结,前哨淋巴结预告腋淋巴结的准确率为９６．７％,假阴性１例。结论：本研究结果证实,乳腺癌前哨淋巴结定位和活检技术是可行的,前哨淋巴结的组织学特征能够准确反映腑淋巴结的状况。我们相信在将来     

纳米碳混悬液示踪前哨淋巴结在甲状腺乳头状癌中的应用

背景与目的:前哨淋巴结活检在指导甲状腺癌的淋巴清扫手术中具有重要意义,其方法有多种.纳米碳混悬液示踪前哨淋巴结技术在胃癌、乳腺癌及结肠癌中有一定的研究,但在甲状腺痛中的研究还处于相对空白阶段.为了寻找一种新的甲状腺癌前哨淋巴结活检方法,本研究旨在探讨纳米碳混悬液示踪甲状腺前哨淋巴结的可行性及有效性,并进一步探讨前哨淋巴结活检在甲状腺痛中的应用价值.方法:用纳米碳混悬液对43例甲状腺乳头状癌患者行前哨淋巴结定位活检.结果:纳米碳标示的前哨淋巴结定位活检的总成功率为93.0%,其准确率为60.5%～88.4%,灵敏度为92.9%.结论:使用纳米碳展示甲状腺痛前哨淋巴结的检测具有自己独特的优势,可以作为一种新的甲状腺前哨淋巴结活检技术,并且这种前哨淋巴结能准确地反映颈部淋巴结的状况,对甲状腺乳头状痛淋巴结转移的判断有较高的参考价值.     

美蓝在乳腺癌前哨淋巴结活检中的应用研究

目的探讨美蓝在乳腺癌前哨淋巴结活检（SLNB）中的可靠性、准确性及其临床应用价值。方法用美蓝对45例乳腺癌患者行SLNB，临床腋淋巴阳性，肿块分期为T4，或怀疑有多病灶性乳腺癌者除外。结果45例33例成功定位活检到前哨淋巴结，成功率73．3％。共100个前哨淋巴结，平均每例3．03个。15例前哨淋巴结呈阳性，其中6例前哨淋巴结为唯一阳性，3例前哨淋巴结阴性而腋窝清扫淋巴结阳性，即假阴性，假阴性率为16．6％。结论美蓝可以较准确地检测出前哨淋巴结，可单独用于乳腺癌前哨淋巴结的定位活检。前哨淋巴结作为第一个接受淋巴转移的淋巴结，能很好地反映区域淋巴结的转移状况。     

蓝色染料和核素方法在乳腺癌前哨淋巴结定位活检中的应用比较

目的探讨蓝色染料和核素方法在乳腺癌前哨淋巴结定位活检中的可靠性、准确性和临床应用价值.方法运用异硫蓝或^99Tc硫胶体结合术中γ探头或联合两种方法对61例腋淋巴结阴性的乳腺癌病人进行前哨淋巴结定位活检.结果前哨淋巴结定位活检总成功率为95.1%(58/61),2例假阴性,假阴性率7.7%,敏感性92.3%,前哨淋巴结预测区域转移准确率96.6%,特异性100.0%.单用蓝色染料方法的成功率88.2%,假阴性率12.5%,敏感性87.5%,准确率93.3%;单用放射核素结合术中γ探头,成功率为95.2%,假阴性率11.1%,敏感性88.9%,准确率95.0%;两种方法联合,成功率100.0%,无假阴性,敏感性100.0%,准确率100.0%.结论前哨淋巴结定位活检在乳腺癌中能很好反映腋淋巴结转移状况,对指导乳腺癌腋淋巴结清扫的必要性和合理性有极大的应用价值.蓝色染料和核素探测两者相互补充,可提高前哨淋巴结的成功率和准确率.     

乳腺癌前哨淋巴结定位活检的意义（附68例分析）

目的：验证乳腺癌前哨淋巴结（SLN）定位和活检技术的可行性及前哨淋巴结的组织化学状况是否能准确预告腋淋巴结转移特性,方法：使用美蓝等对68例确认为乳腺癌患进行术中前哨淋巴结定位活检术,结果：58例（85．3％）SLN,SLN预告腋淋巴结的准确率为91．4％（53／58）,假阴性为8．6％（5／58）,结论：乳腺癌SLN定位活检是可行的,SLN可较为准确地反映腋淋巴结状况。     

乳腺癌前哨淋巴结临床病理的研究

目的：探讨乳腺癌前哨淋巴结能否准确反映腋窝淋巴结转移情况,方法对36例例早期乳腺癌,常规HE染色检测腋窝淋巴结,对HE染色阴性的前哨淋巴结及所属非前啉巴结,连续切片、免疫组化染色,检测其肿瘤的转移情况,结果常规病理检测36例中,10例腋窝有转移,其中2例仅哨淋巴结有肿瘤转移,连续切片,组化检测26例阴性的前哨淋巴结共61例,非前哨淋巴结406枚,2例（2枚）仅前哨淋巴结发现有肿瘤转移,余245例前哨淋巴结及非前哨淋巴结无肿瘤转移,HE染色的检测阴性的前哨淋巴结患者假阴性率为7．7％（2／26）。结论早期腺癌前哨淋巴结可以准确反映腋窝巴结转移情况。     

前哨淋巴结活检在早期乳腺癌中的应用价值

目的：探讨活性染料亚甲蓝检测早期乳腺癌前哨淋巴结的可行性及其临床意义。方法：利用亚甲蓝对48例乳腺癌患者进行前哨淋巴结活检（SLNB）并同时行腋窝淋巴结清扫（ALND）,根据病理结果进行评价。结果：SLN检出率为95．8％,SLN对ALN状况预测的敏感度为90．3％,准确率为95．7％,假阴性为6．5％,假阳性为0。结论：前哨淋巴结活检能比较准确地反映早期乳腺癌的腋窝淋巴结转移情况,可为SLN阴性的患者“保腋窝”提供依据。     

不同示踪剂对乳腺癌前哨淋巴结检出率和假阴性率的影响

目的评价不同示踪剂对乳腺癌前哨淋巴结检出率和假阴性率的影响。方法106例经空心针穿刺活检诊断为乳腺癌并且临床上腋下淋巴结阴性的患者,分别使用99mTc标记的硫胶体、99mTc标记的硫胶体联合亚甲蓝、亚甲蓝作为示踪剂进行前哨淋巴结活检,随后进行腋下淋巴结清扫,所有获得的淋巴结进行病理学检查。结果99mTc标记的硫胶体作为示踪剂时,前哨淋巴结检出率为91.4%,假阴性率15.8%,敏感性81.2%;99mTc标记的硫胶体联合亚甲蓝为示踪剂时,检出率为94.6%,假阴性率5.0%,敏感性93.8%;亚甲蓝作为示踪剂检出率为88.2%,假阴性率6.3%,敏感性93.3%。结论99mTc标记的硫胶体联合亚甲蓝为示踪剂时,前哨淋巴结的检出率高、假阴性率低,是一种理想的示踪剂。     

Sentinel lymph node biopsy is not accurate in predicting lymph node status for patients with cervical carcinoma

BACKGROUND: The authors evaluated the accuracy of sentinel lymph node biopsy in predicting lymph node status for patients with early cervical carcinoma. In particular, the authors set out to determine the false-negative rate associated with sentinel lymph node biopsy in this setting. METHODS: Twenty-nine consecutive patients with early cervical carcinoma who were treated with pelvic laparoscopic lymphadenectomy and radical surgery underwent sentinel lymph node biopsy following lymphatic mapping with patent blue dye. All sentinel and nonsentinel lymph nodes were evaluated for micrometastases via multilevel sectioning followed by immunohistochemical staining. RESULTS: At least one sentinel lymph node was identified for each patient. On routine pathologic evaluation, 3 patients (10%) were found to have positive lymph nodes. Among the remaining 26 patients, multilevel sectioning in conjunction with immunohistochemical analysis identified 5 patients (19%) who had micrometastases in the pelvic lymph nodes. Two of these five patients had micrometastases in a sentinel lymph node; however, the more notable finding was that the other three patients had micrometastases in nonsentinel pelvic lymph nodes despite having negative findings on sentinel lymph node biopsy. Thus, the negative predictive value of sentinel lymph node biopsy in the current study was 87.5%. CONCLUSIONS: Multilevel sectioning followed by cytokeratin immunohistochemistry may identify additional patients who have lymph node micrometastases; in the current study, this technique identified cases in which micrometastases were present in nonsentinel lymph nodes even when sentinel lymph nodes were found to be negative for disease on biopsy. This high false-negative rate associated with sentinel lymph node biopsy, raises questions regarding the validity of the sentinel lymph node concept in cervical carcinoma.     

cN0舌癌前哨淋巴结定位方法研究

背景与目的：由于没有任何临床检查方法或生化标志能准确的评价临床NO（clinically negative neck,cNO)舌癌颈部淋巴结转移的状况。因而,目前对cNO舌癌的颈部治疗存在一定的盲目性。前哨淋巴结（sentinel node,SN)活检的应用为指导cNO舌癌患者颈部的个体化治疗提供了依据。本研究旨在探讨SN活检能否准确评价cNO舌癌的颈部淋巴结转移状况,寻找舌癌前哨淋巴结定位的最佳方法。方法：使用术前核素扫描法和术中亚甲蓝示踪法对24例cNO舌癌患者进行SN示踪,研究SN活检在评价cNO舌癌颈部淋巴结转移状况中的作用。对比核素扫描法,亚甲蓝示踪法,两法结合示踪法的优缺点。结果：3种方法全组SN检出率均为100%,24例中有4例手术标本发现有颈淋巴结转移（即隐匿性颈淋巴结转移,cNOpN^ ),SN活检对全组病例颈部淋巴结转移状况评价的准确率为100%。无假阴性;平均检出SN数目;核素扫描法3.5枚/例,亚甲蓝示踪法2.7枚/例,两法结合示踪法2.2枚/例。结论：核素扫描法和亚甲蓝示踪法均能有效地对cNO舌癌进行SN定位并准确地评价颈部淋巴结转移状况,两法结合SN示踪法最为准确。并且具有可操作性和实用性。     

头颈部癌前哨淋巴结的临床研究

目的 探讨头颈部肿瘤前哨淋巴结的检测及其对淋巴结转移的预测价值。方法 用手术中注射蓝染料的方法,对51例未经治疗的头颈部癌颈淋巴结NO的患者进行了手术中前哨淋巴结的临床研究。手术中取前哨淋巴结作快速冰冻病理,并与手术后常规石蜡切片病理对照,观察冰冻病理前哨淋巴结转移和常规病理颈淋巴结转移的相关性及其对颈淋巴结转移 癌的预测值。结果 51例中48例成功的显示了前哨淋巴结,成功率94．1％,前哨淋巴结平均每例每侧2．5枚。11例前哨啉巴结阳性,其中2例有前哨淋巴结以外的颈淋巴结转移,2例为假阴性。前哨淋巴结对颈淋巴结转移的总阳性预测值为85％。结论 前哨淋巴结检测对头颈部癌的淋巴结转移有重要的预测价值。     

甲状腺癌前哨淋巴结的临床及病理研究

目的 :探讨甲状腺癌前哨淋巴结的检测及其对颈淋巴结转移的预测价值。方法 :用手术中注射蓝染料的方法 ,对 30例甲状腺癌患者进行了手术中前哨淋巴结的临床研究 ,手术中取前哨淋巴结作快速冰冻病理 ,并与手术后常规石蜡切片病理对照 ,观察冰冻病理前哨淋巴结转移与常规病理颈淋巴结转移的相关性 ,及其对颈淋巴结转移的预测价值。手术后以抗角蛋白单抗行一步法免疫组化染色 ,并与常规HE染色对照。结果 :30例甲状腺癌中 2 7例成功的显示了前哨淋巴结 ,成功率 90 %。 2 7例前哨淋巴结平均每例 4枚 ,13例前哨淋巴结阳性的患者 ,其中 2例有前哨淋巴结以外的颈淋巴结转移 ;2例假阴性 ,前哨淋巴结对颈淋巴结转移的总的阳性预测值 86.7%。结论 :前哨淋巴结检测对甲状腺癌的颈淋巴结转移有重要的预测价值。     

不同示踪剂在早期宫颈癌前哨淋巴结定位中的临床应用

目的 对比分析纳米炭与亚甲蓝在早期宫颈癌前哨淋巴结定位中的应用效果,为临床示踪剂选择提供参考.方法 选择确诊为早期宫颈癌的60例患者作为研究对象,采用数字随机表法分为纳米炭示踪组和亚甲蓝示踪组,每组30例.两组患者均于手术同期行前哨淋巴结活检,纳米炭示踪组患者采用纳米炭作为示踪剂,亚甲蓝组采用亚甲蓝作为示踪剂,两组患者均行腹腔镜或开腹手术,术中切除探查前哨淋巴结,亚甲蓝组患者蓝染淋巴结为前哨淋巴结,纳米炭组患者以黑染淋巴结为前哨淋巴结,均予以切除.术中行广泛切除全子宫及淋巴结清扫术,同时于腹主动脉旁取样淋巴结,术中均采用快速冰冻切片法和组织免疫法对前哨淋巴结、清扫的所有淋巴结及腹主动脉旁淋巴结进行病理检测.结果 30例亚甲蓝示踪组患者中切除淋巴结254个,共检出前哨淋巴结38个,SLN肿瘤转移2枚,病理检查肿瘤转移5枚;纳米炭示踪组患者切除淋巴结261个,前哨淋巴结检出44个,SLN肿瘤转移4枚,病理检测肿瘤转移4例.纳米炭示踪组前哨肖淋巴结检出率明显高于亚甲蓝示踪组(P＜0.05),两组患者的定位分布构成比比较差异无统计学意义(P＞0.05).亚甲蓝示踪组检出前哨淋巴结转移的敏感性为33.3％、准确性为80.0％、特异性为87.5％.纳米炭示踪组检出前哨淋巴结转移的敏感性为80.0％、准确性为86.7％、特异性为88.0％.结论 纳米炭宫颈注射进行宫颈恶性肿瘤前哨淋巴结的检测技术优于亚甲蓝,是临床可行的,但还需要大量的临床研究进一步证实.     

乳腺癌前哨淋巴结活检40例报告

目的 :通过对乳腺癌前哨淋巴结 (SLN)活检 ,探讨其对腋淋巴结转移情况预测的准确性。方法 :采用亚甲蓝染料法对 4 0例乳腺癌行腋窝蓝染淋巴结活检 ,后行常规腋窝淋巴结清除 (ALND) ,两标本均送病理检查。结果 :全组 4 0例患者检出SLN 38例 ,2例未找到SLN ,检出率为 95 % ( 38/ 4 0 ) ,有 8例SLN为阳性 ,1例SLN为假阴性 ,腋窝淋巴结 (ALN)有 9例转移 ,SLN与ALN病理检查完全符合者 37例 ,准确率为 92 5 % ( 37/ 38) ;灵敏度为 88 9% ( 8/ 9) ;假阴性率为 11 1% ( 1/ 9)。结论 :亚甲蓝染色法能准确地鉴别SLN及预测乳腺癌腋窝淋巴结状态     

甲状腺乳头状癌前哨淋巴结活检的临床意义

目的 探讨甲状腺乳头状癌颈部前哨淋巴结(SLN)活检的准确性及可行性.方法 前瞻性分析23例临床淋巴结阴性(cNO)的甲状腺乳头状癌患者,术前2～5 h在超声引导下瘤体内注入99Tcm-右旋糖酐(99Tcm-DX)74 MBq,术中在肿瘤周围注入亚甲蓝0.2～0.4 ml.采用核素法(淋巴结闪烁显像法+γ探针法)和染料法定位SLN,并行术中冰冻病理检查,与术后颈清扫标本常规病理进行对照.结果 23例甲状腺乳头状癌患者均检测出SLN,检出率达100%(23/23).其中染料法和核素法的检出率分别为87.0%和100%.23例患者中,SLN冰冻阳性12例.1例术中冰冻检测SLN未发现转移癌而术后常规病理发现转移;1例SLN冰冻及病理均未发现转移,但颈清扫标本中非SLN(Ⅵ区)有转移.有21例患者的SLN活检结果与术后颈部淋巴结常规病理结果相符,准确度为91.3%(21/23),阳性预测值为100%(12/12),阴性预测值为81.8%(9/11).结论 SLN活检对预测cNO甲状腺乳头状癌的颈部淋巴结转移和指导临床治疗有重要的意义.     

Sentinel lymph node biopsy in patients with papillary thyroid carcinoma.

BACKGROUND: It remains controversial whether modified radical neck dissection (MRND) for patients with papillary thyroid carcinoma improves prognosis. However, it is highly probable that the incidence of local recurrence is reduced by lymph node dissection. Sentinel lymph node (SLN) biopsy (SLNB) for patients with melanoma and breast carcinoma has been validated as an accurate method for assessing lymph node status. The objective of this study was to determine the feasibility of SLNB for the evaluation of cervical lymph node status in patients with papillary thyroid carcinoma. METHODS: After injection of methylene blue around the tumor in 22 patients with papillary thyroid carcinoma, blue-stained lymph nodes were dissected as SLNs. After the SLNB, all patients also underwent subtotal thyroidectomy and MRND. SLNs and other lymph nodes were investigated with regard to their number, distribution, size, lymph node status, and ratio of metastatic area. RESULTS: There was concordance between the SLN findings and the regional lymph node status in 19 of 21 patients (90.5%; 7 patients had both positive SLN and regional lymph node results, and 12 patients had both negative SLN and regional lymph node results). Two patients had negative SLN results but, in the end, had positive nonsentinel lymph nodes (NSLNs). The overall reliability rate of SLNB was 86.3% (19 of 22 patients). The authors experienced no complications with the use of methylene blue for the detection of SLNs. CONCLUSIONS: SLNB using methylene blue is feasible technically and is safe, and the findings correlate with cervical lymph node status. Therefore, SLNB is a good technique for estimating the status of cervical lymph nodes in patients with papillary thyroid carcinoma.     

美蓝在乳腺癌前哨淋巴结活检中的临床价值

目的探讨美蓝在乳腺癌前哨淋巴结活检中的临床价值。方法将1%美蓝2ml注入活检腔外上方的皮下及乳腺组织内,然后行Auchincloss仿根治术,依淋巴管走向找到蓝染淋巴结定为SLN,若此时未找到待腋窝清扫结束后,再在标本中寻找,蓝染者为SLN,余为非SLN,分别送病理检查。结果前哨淋巴结检出率为87.9%(95/108),SLN预测腋窝状况的准确率为95.7%(91/95),假阴性率为6.5%(4/62),无假阳性者。未检出者13例,其中4例为假阴性,均属跳跃式转移。前哨淋巴结转移阳性率(34.6%,33/95)和阴性率(65.3%,62/95),与全腋淋巴结转移阳性率(39.8%,43/108)和阴性率(60.2%,65/108)比较,均无显著性差异(P>0.05)。结论美蓝前哨淋巴结活检可以准确预测乳腺癌患者的腋淋巴结状态。     

Sentinel Node Biopsy in Early Breast Cancer Patients with Palpable Axillary Node

Background: Sentinel lymph node biopsy is a reliable method for evaluation of the axillary lymph node status in early stage breast cancer patients with non-palpable lymph nodes. The present study evaluated the status of sentinel and non-sentinel lymph nodes in T1T2 patients with palpable axillary lymph nodes. Materials and Methods: One hundred and two women with early breast cancer were investigated in this study. Patients were selected for axillary sentinel lymph node biopsy and then surgery .Then the rates of false negative and true positive, and diagnostic accuracy of sentinel lymph nodes biopsy were evaluated. In addition, the hormone receptors status of the tumor was determined through IHC and data was analyzed in SPSS21. Results: In this study, the mean age of the patients was 49 years, 85% had invasive ductal carcinoma  in their pathology reports, 77% were ER/PR positive, 30% HER2 positive and 9.8% triple negative and 69% had KI67<14%. In frozen pathology, 15.7 and 84.3% were sentinel positive and negative, respectively, and in the final pathology, 41 and 58.8% were sentinel positive and negative, respectively. This difference arises from the false negative rate of the frozen pathology, which was about 31.3%. The sensitivity, specificity, and diagnostic accuracy of the frozen section were 24, 90 and 43%, respectively. Lymphovascular invasion is an important effective factor in the involvement of sentinel and non-sentinel lymph nodes. Statistical analysis showed that the probability of sentinel and non-sentinel lymph nodes involvement was higher in receptor positive patients and those with KI67>14% (p<0.002) whereas the rate of involvement was lower in triple negative patients. Conclusion: Sentinel node biopsy can be used in a significant percentage of breast cancer patients with palpable and reactive axillary lymph nodes.